Lecture 8/Chapter 7 Flashcards
1
Q
Learning objectives
A
- outpatient, ambulatory, and primary care
- principles behind patient-centered medical homes and community based primary care
- reasons for dramatic growth in outpatient services
- various types of outpatient settings and services
- role of complementary and alternative medicine
- primary care delivery in other countries
- impact of ACA on primary care
2
Q
outpatient and primary care services
A
- the terms outpatient and ambulatory are used interchangeably
- hospitals provided majority of outpatient care
- independent providers faced capital constraints
- consumer demand fueled growth of complementary and alternative medicine
- ACA addresses access for poor and vulnerable
3
Q
what is outpatient care***
A
- outpatient services or ambulatory care
- does not require an overnight stay incurring room and boards cost
- ambulatory care similar to community medicine because it serves:
- surrounding community
- convenience
- accessibility
- the most basic outpatient services are physicals and minor treatment in physician office
4
Q
ambulatory care
A
- diagnostic and therapeutic services for the walking patient
- used synonymously with community medicine
- moving yourself
- ambulatory care similar to community medicine because it serves:
- surrounding community
- convenience
- accessibility
5
Q
outpatient services
A
- services not provided with an overnight stay
- great growth in outpatient care
- new settings, types, ownership, services
- physical exams
- minor treatment
- advanced outpatient in a hospital base setting
- physical exams and minor treatment are the most basic services
6
Q
scope of outpatient services
A
- primary care is the foundation for ambulatory health services
- services other than primary care are an integral part of outpatient services
- technological advances allow treatments to be provided in ambulatory care settings
- hospital inpatient services continues to decline since 1980s
- executives see ambulatory care as an essential, no longer a supplemental service line
- hospital survival can depend heavily on ambulatory care*
- competition from health health agencies, ambulatory care, urgent care, outpatient surgery
7
Q
primary care
A
- the foundation for ambulatory care
- plays a central role in a health care delivery system
- foundation of ambulatory care
- all primary care is outpatient, but not all outpatient care is primary care* -> emergency room, urgent care treatment, outpatient surgery, rehabilitation, renal dialysis, chemotherapy
- distinguished from secondary and tertiary care by duration, frequency, and intensity
- secondary and tertiary care are more complex and specialized
8
Q
secondary care
A
- usually short term
- sporadic consultation from a specialist
- includes hospitalization
- routine surgery
- specialty consultation
- rehabilitation
9
Q
tertiary care
A
- most complex level of care
- uncommon conditions
- institution based
- highly specialized
- technology driven
- rendered in large teaching hospitals
10
Q
health care service frequency
A
- primary care- 75-85% of population requires only primary care
- secondary care- 10-12% requires referral to short term secondary care
- tertiary care- 5-10% require tertiary care
11
Q
world health organization definition of primary health care
A
- world health organization (WHO, 1978)
- essential health care based on scientific acceptable methods
- universally accessibly and acceptable
- at an affordable cost
- to maintain at every developmental stage
- first level of contact*
- bringing health care as close as possible to where people live and work
- as part of a continuing health care process
12
Q
institute of medicine definition
A
- IOM define primary care
- comprehensively addresses any health problem at any stage of patients life
- coordination ensures a combination of health services to best meet the patients needs
- continuity of care administered over time
- emphasizes accessibility and accountability
13
Q
primary care and the ACA
A
- four primary care provisions:
- increased medicare and medicaid payments
- new incentives for primary care providers working in underserved areas
- expansion of the health center program and strengthening of the capacity of health centers
- creation of additional training programs
14
Q
patient centered medical homes (PCMH)
A
- team oriented approach for special needs children requiring constant care coordination
- initially consisted of an interdisciplinary team of physicians and allied health professionals
- studies demonstrated a positive impact
- PCMH assessment tools
15
Q
community oriented primary care elements
A
- reducing exclusion and social disparities
- organizing health services around peoples needs
- integrating health into all sectors
- pursuing collaborative models of policy dialogue
- increasing stakeholder participation
16
Q
primary care providers: US primary care practitioners
A
- are not restricted to physicians trained in general and family practice
- includes internal medicine, pediatrics, and obstetrics and gynecology
17
Q
primary care providers: nonphysician practitioners (NPPs)
A
-nurse practitioners (NPs), physician assistants (PAs), and certified nurse-midwives (CNMs)
18
Q
growth in outpatient services
A
- reimbursement
- technological factors
- utilization control factors
- physician practice factors
- social factors
19
Q
types of outpatient care settings and methods of delivery
A
- private practice
- hospital based services
- freestanding facilities
- retail clinics
- mobile medical, diagnostic, and screenings
- home health care
- hospice services
- ambulatory long term care services
- public health services
- community health centers
- free clinics
- other clinic
- telephone access
20
Q
hospital-based services
A
- clinical services
- surgical services
- emergency services
- home health care
- womens services
- urgent care
21
Q
freestanding facilities
A
- walk in clinics
- urgent care centers
- surgicenters
- preferred by patients
22
Q
mobile medical, diagnostic, and screenings
A
-EMTs and paramedics
23
Q
hospice services
A
- comprehensive services for terminally ill with life expectance of 6 months or less
- staffing on 24 hours basis
- medical and nursing care
- access to inpatient care
- social services and support
- therapy and access to supplies
- Two areas of emphasis:
- palliation (pain management) with psychosocial and spiritual support
- specific conditions for medicare certification
24
Q
which of the following had the greatest impact on increasing the QUALITY of health care
A
- licensing healthcare professionals- improves quality of care
- medical insurance- improves access
- government pensions- improved quality of life not healthcare
- technology- improves quality of care
